Versión en castellano

Katy’s pregnancy and maternity

Katy cries at the restroom on the second floor of the school. She is leaning on her wrists on the sink, her head sunk to the floor. At times she raises his face to the mirror, but immediately covers it with both hands. She splashes water on her face and dries herself as she can. She takes the courage to leave and at the door she runs into Renata and Amy, her best friends.
—What ’s wrong? You’re blushing, you’re crying! —The girls say in chorus.
—I’m pregnant —she answers like a sharp blow.
They hug her.
—What if what happened to Carmen happens to me?
—No, everything will be fine —I’m sure your parents will support you —says Amy.
—But you have to talk to them, and to Miguel —We support you. We are with you —adds Renata.
—I’m only 15 years old, what am I going to do? —She sobs.
Katy doesn’t want to talk anymore. She cleans her face again and returns to stay in class. In the hallway, as she walks into the living room, she wonders how Miguel would react upon hearing the news. Surely since he is 24 years old, he would know what to do. She sits at her table and takes the books out. As she scribbles on her notebook, he thinks of her family. They had tried so hard to get by with the clothing store near the plaza. What will they tell her? Would they be disappointed?

Audio 1

Like Katy, in Peru, one in 10 women between 15 and 19 years old is a mother. In 2017, there were 122,144 adolescents in this age range who were deeply affected in their health, education, job opportunities and life plans after pregnancy. Though the percentage of adolescents with children in Peru has decreased from 11.9% to 10.1% between 2007 and 2017, it has increased slightly (from 2.0% to 2.1%) among 15-year-old women1. This is also Katy’s age, who will turn 16 next July.

Figure 1. Adolescent women with children (2007-2017)

Source: Population and Housing Census (2017). Own elaboration.

Three out of every four girls or teenagers with children in Peru are—or have been—in some type of early union. The average age difference of the partners in these relationships is seven years older, and since there is so much age difference, power dynamics often accentuate inequality and gender-based violence, and diminish the autonomy of women.
Katy and her family live in a city in the Andes. In Peru, 10% of women who, like Katy, identify as Quechua, have already had a child or are pregnant2, but adolescent pregnancy and maternity rates are even higher in other contexts. Among the adolescents who self-identified as Ashaninka, Shipibo-Konibo or Awajún, more than a quarter have already had a child3.

Figure 2. Adolescent maternity rate, according to ethnic self-identification (2019)

Note: Excludes women who did not report the total number of children born alive.
Source: Population and Housing Census (2017). Own elaboration.

There are also big differences in terms of household income. In the lowest-income quintile, the proportion of adolescent women who are pregnant or already mothers is 24.9%, while in the highest-income quintile this proportion is only 3.2%.4

Figure 3. Rate of adolescents who are mothers or pregnant, by income quintile (2019)

Source: National Demographic and Family Health Survey (2019). Own elaboration.

Katy leaves school and goes to her parents’ store She takes the path by the river and continues thinking as she watches the downstream towards her way. She fixes her gaze on the water and looks for the reflection of her face, this time without fear. She sends a WhatsApp message to Miguel to tell him the news. Would she have to drop out of college? —she wonders. The school year was just beginning.

Audio 2

In Peru, school dropouts due to pregnancy and dedication to unpaid domestic work occur in 13.2% of all women between 15 and 24 years old who have at least one child. According to the National Household Survey (2019), women who had children during adolescence reached a lower average educational level compared to women who had children in their adulthood. Only one in five women who had children in adolescence manages to complete higher education, but among those who have children in adulthood, one in four achieves this goal. Having become pregnant reduced the probability that Katy will be able to access higher education by 33% compared to her friends Amy and Renata, who will become pregnant after 19 years5.

Figure 4. Educational level achieved by groups of women (2019)

Source: National Household Survey (2019). Own elaboration.

In a few years, Katy will learn that by not being able to continue her studies after finishing high school, her salary will stagnate around USD 2,922 per year, and that compared to Amy and Renata, she will earn USD 2,683 less per year. Had she postponed her pregnancy, Katy could have used that money to pay for English classes, like Amy did, or to prepare for college, like Renata6.

Figure 5. Percentage of women with higher or postgraduate education according to age at the time of having their first child

Source: National Household Survey. Own elaboration.

Katy arrives at her house and spreads the news bluntly. At the beginning neither her mother nor her father say a word. Then… how, when, who, why? Katy hardly puts together short sentences. After a long conversation, she decides that she will continue the pregnancy with the support of her parents, but she will have to make several sacrifices. Among them, she’ll have to postpone studies. However, for now, she must seek medical assistance for her pregnancy.

Audio 3

In nine months, Katy had to attend pregnancy checks valued at a total of USD 530, and her cesarean delivery cost USD 298. Katy was able to get health attention for free through the Seguro Integral de Salud (the government’s universal insurance), but her pregnancy—even though it had no complications— cost the government USD 828 in total. Carmen, a schoolmate who got pregnant a year before Katy, was not as lucky as her. Unlike Katy, Carmen became pregnant as a result of a non-consensual relationship and when she was taken to a public health center, she was not provided with information on emergency oral contraception (ECP). Carmen had to face an unwanted pregnancy as a result of a crime and without access to the information or the medicines that corresponded to her as part of her reproductive rights. In Carmen’s case, the State had to finance additional interventions to treat a hemorrhage before delivery (USD 269) and interventions against the low birth weight of her baby (USD 782). Despite this, Carmen, like 34 other pregnant adolescents in 2019, died during the delivery, at the age of 167. If she had had the tools to delay her pregnancy, she probably would have been able to live to be 76. In financial terms, Carmen’s death meant a loss of annual income of USD 3,055 for a period of 48 years of productive life.
Two years after giving birth, Katy, already 18 years old, decides to look for work to cover the necessary expenses to support her daughter, but she faces new difficulties. Her housework leaves her very little time for job hunting, and the hours that she could drop her daughter off at day care are not enough to allow her to accept the few jobs she was offered. She then decides to prepare lunches for the workers in her neighborhood. This allows her to generate some income, but since she has no help other than that of her parents, her plans to resume her studies must continue to be postponed.

Audio 4

Along with her pregnancy, Katy’s chances of having a job and working in the formal sector were reduced. Although she was able to generate her own employment (subsistence and informal), more than a quarter of women who had their first child in adolescence are economically inactive (26.8%), compared to 19.1% for those who had children in adulthood. Among economically active women, unemployment and informality rates are also higher for those who had their first child before the age of 19. Considering the employment gap of 3.3 percentage points (p.p.) and the 4.5 p.p. formality gap8, Amy and Renata, who became mothers after 19, have a higher probability of being economically active and employed.

Figure 6. Status of activity, employment and labor formality of women according to age at birth

Source: National Household Survey 2019. Own elaboration.

Katy is 28 years old and continues to sell meals in her neighborhood. Could she get a better job? She had tried so in recent years, but although her daughter is already going to school and that gives her a little more time, during these years, her low income and savings capacity, and her efforts to prioritize her daughter’s development did not allow her to accumulate skills to improve her employability. That is why for the rest of her productive life the jobs that Katy will be able to access will have a remuneration that, on average, will be USD 599 less per year than other women who became pregnant in adulthood and have the same education level as her.

Figure 7. Average annual labor income of women according to the age at which they were mothers

Source: National Household Survey 2019. Own elaboration.

Mothers who had children in adolescence begin to work earlier than those who became mothers in adulthood, but once they are forced to reduce investment in their own human capital (education and health), their wages become lower throughout her life9. This means that if Katy could have postponed her pregnancy for four years, in the 48 years of productive life that she could have had, she would have accumulated additional USD 28,75210. With that money, Katy could have bought a small house, financed her university degree, or improved the living conditions of her daughter.

Compared to an average woman who postponed her pregnancy up to age 19, Katy accumulated opportunity costs, at different stages of her life, for a total of USD 36,178. These costs correspond to:

In Carmen’s case, having lost her life before beginning her productive years, her opportunity costs correspond exclusively to non-generated income of USD 146,640.

Figure 8. Total annual costs of adolescent pregnancy assumed by the adolescent, at the individual level

Source: National Household Survey 2019. Own elaboration.

Katy’s pregnancy and early motherhood also has a cost for the government in health care and foregone tax revenue. On the one hand, Katy generated costs of USD 828 in health care related to her pregnancy and delivery. On the other hand, the decrease in her economic activity as a consequence of her pregnancy caused the government to stop receiving income for a total of USD 170 per year from VAT and income tax.

Katy’s story could be that of one in ten Quechua adolescents facing premature pregnancies in Peru. From now on, her life will be more complicated since her early motherhood increased her chances of falling into poverty and transmitting it to her daughter, as well as facing scenarios of social and gender inequalities during her life.

Costs at the aggregate level

Katy is a fictional character built on the basis of average, modal and approximate values ​​of the 81,240 real stories of adolescent pregnancy in Peru during the year 2019. The basis for her construction was the study “Socio-economic consequences of pregnancy and adolescent motherhood in Peru”, which estimated the economic impact of teenage pregnancy and motherhood on the lives of these women and their families, as well as on the economy and development of Peru.

The study is part of the implementation of the MILENA 1.0 methodology to estimate the socioeconomic impact of adolescent pregnancy and motherhood in Latin American and Caribbean countries. The MILENA 1.0 methodology measures the effects of pregnancy and adolescent motherhood on five dimensions: (i) education, (ii) labor participation, (iii) income, (iv) health and, (v) on tax revenue not received from taxes at the aggregate level; and it was developed within the framework of the regional initiative “165 million reasons to invest in adolescence and youth” of UNFPA and the strategic planning 2017-2022 of Plan International Peru, in the component of Health and Sexual and Reproductive Rights.

The conclusions of the study show that women who had their first child in adolescence (MHA) have a series of disadvantages compared to those who had it in adulthood. MHA receive a 13.8% lower annual income, have higher rates of unemployment and labor informality, work in economic activities and occupational categories with lower salaries, and reach lower levels of education. In addition to the problems that this entails in terms of low accumulation of human capital, difficulties in breaking the intergenerational transmission of poverty, health risks and other aspects, the quantification of the economic impact for the country is of great magnitude.

Figure 9. Total economic impact of adolescent motherhood (2019, USD)

Source: National Household Survey 2019 and Integrated Financial Administration System 2019. Own elaboration.

The total opportunity costs associated with adolescent motherhood in Peru in 2019 were USD 329,416,367 (1,159,545,612 soles), equivalent to 0.14% of GDP for the same year. In addition, the costs derived from the State’s spending on health care were USD 57,987,348 (204,115,465 soles), and the costs derived from the lower tax collection reached USD 73,051,374 (257,140,837 soles). These costs can be divided into five categories:

1. Opportunity cost of education

Considering the educational gaps between MHA and women who had their first child in adulthood, as well as the earnings corresponding to each educational level, the study estimates that the opportunity cost of education associated with pregnancy and adolescent motherhood was USD 94 million (260 million soles) during 2019.

2. Opportunity cost of work activity

The proportion of economically active women among those who had children in adolescence is 26.8%, 7.7 p.p. above 19.1%, which is the inactivity rate among women who had their first child in adulthood. The fact that the percentage of inactivity is higher among MHA generates an annual opportunity cost of USD 109 million (385 million soles).

3. Opportunity cost of employment

Among economically active women, MHA also have a higher unemployment rate (7.7% versus 4.4%) and a higher informality rate (81.9% versus 77.4%). This generates an opportunity cost of employment that amounts to USD 48 million (171 million soles).

4. Opportunity cost of labor income

The unearned income due to lower wages of MHA (USD 3,488 per year, on average) compared to what they would have obtained if their human capital formation had not been interrupted by early motherhood (USD 4,047 per year), reaches USD 73 million (260 million soles). At the regional level, the departments with the highest income gap between MHA and women who had children in adulthood were Pasco, Puno, Huancavelica, San Martín and Junín.

Figure 10. Average annual income of women by department, according to age at the time of having the first child (2019)

Source: National Household Survey 2019. Own elaboration.

In addition to this, the economic costs of maternal mortality must be considered, which can be quantified from the years of potential life lost. According to the Ministry of Health (2019), the number of maternal deaths was 309 in 2019, 34 of which occurred in adolescents. This is equivalent to 1,625 years of potential productive life, which at the national level means a social loss due to maternal mortality equal to USD 5 million (17 million soles) per year.

5. Government costs

Teen pregnancies and motherhood represent costs for the State on two levels. First, the fact that adolescent mothers see their income and work activity reduced caused the State to have unearned tax income of USD 73 million (257 million soles) in 2019.

On the other hand, the government incurred expenses of USD 58 million in maternal health care for women 19 years of age or younger. These expenses are broken down into prenatal and delivery care (USD 25 million), deliveries (USD 19 million), obstetric complications (USD 0.3 million), other maternal conditions (USD 2 million) and interventions per newborn (USD 12 millions).11

Figure 11. Health care costs for adolescent-age women with children (2019, USD)

Source: Integrated Financial Administration System 2019. Own elaboration.

The impact of teenage pregnancy and motherhood is not evenly distributed among the entire population. From the total opportunity costs of USD 329,416,367, adolescent mothers of non-poor households bear USD 251,674,104. The burden is also carried mostly by urban households (USD 274,074,417) and by mothers with mixed ethnic self-perception (USD 178,594,999).

Figure 12. Disaggregation of the total impact of adolescent motherhood by characteristics of women and their households (2019, USD)

Source: National Household Survey 2019 and Integrated Financial Administration System 2019. Own elaboration.

Considering the groups that will require greater attention from public policies aimed at reducing adolescent pregnancy and motherhood, the study proposes a set of policy recommendations for the various actors responsible for the prevention of adolescent pregnancy and motherhood in Peru (table 1).

Table 1. Evidence-based policy recommendations

Strategies Key points
Strengthening of public health policies and services Prioritize and strengthen the effectiveness of adolescent pregnancy prevention policy and programs through the implementation of effective evidence-based interventions.
Ensure continuity and/or reestablishment of sexual and reproductive health services in the context of the Covid-19 pandemic.
Strengthen differentiated comprehensive adolescent health services.
Provide modern contraceptive methods free of charge.
Prevention of a possible second pregnancy
Expand coverage of prenatal, delivery and postpartum care services.
Expanding access to emergency obstetric care.
Ensuring that adolescents and their families are prepared for childbirth and other emergencies.
Removing administrative barriers to facilitate access to therapeutic abortion.
Informing community members about the importance of prenatal and postpartum care.
Measures for the improvement of education services for pregnant adolescents and adolescents mothers Guarantee access to quality public education for all girls and adolescents nationwide.
Guarantee comprehensive sex education in the regular basic education curriculum.
Development of competencies, socio-emotional aspirations and reinforcement of soft skills.
Guarantee the reintegration of girls and adolescents into school due to pregnancy and/or maternity.
Ensuring continuity of basic education in the context of the Covid-19 pandemic.
Sensitize the educational community on the situation of adolescent pregnancy.
Measures for the improvement of job placement services for pregnant adolescents and adolescents mothers Guarantee access to adolescents mothers in labor market insertion.
Provide support actions and facilities for adolescents mothers to combine work and family life.
Offer adolescents mothers a training proposal that help them to generate training and productive possibilities.
Measures for the improvement of social protection services for pregnant adolescents and adolescent mothers Guarantee the protection of all girls and boys at the national level.
Strengthen the system of administration of justice by which to ensure that sentence for rape and sexual abuse convictions are effectively enforced.
Empowering girls and adolescents.
Promoting social norms that condemn coercion in sexual relations

Own elaboration.

In 2019, the economic impact of pregnancy and adolescent mortality reached USD 329,416,367, but if we are not able to reduce adolescent pregnancy in the future, the increasing trend in household income will mean that lost income will be higher and higher, so the opportunity costs of adolescent pregnancy will grow exponentially. The results of the estimation of the socioeconomic consequences of adolescent pregnancy and motherhood are an urgent call for the need for effective public policies based on evidence that contribute to the prevention of this serious problem of social development, gender inequality, exclusion and violation of people’s rights.

Read the full study here.

  1. Population and Housing Census (2017)↩︎

  2. Population and Housing Census (2017)↩︎

  3. Population and Housing Census (2017)↩︎

  4. National Demographic and Family Health Survey (2019)↩︎

  5. In urban areas, the effect of having had a child in the last three years reduces the probability of accessing higher education by 33%, while in rural areas this probability is reduced by 39% (Mendoza and Subiria 2013)↩︎

  6. Considering a salary difference of USD 2683 between the average salary of women who only manage to complete secondary education (USD 2922) versus those who manage to complete higher education (USD 5605)↩︎

  7. Ministry of Health - MINSA (2019) Boletín Epidemiológico del Perú (Volumen 28. SE 52. Semana Epidemiológica del 22 al 28 de diciembre). https://www.dge.gob.pe/epipublic/uploads/boletin/boletin_201952_30_095358.pdf↩︎

  8. National Household Survey (2019)↩︎

  9. Tobar, F. (April 27, 2021). Una lectura socioeconómica del Embarazo en la Adolescencia en América Latina [Conference]. Presentation of the results of the MILENA 1.0 study - UNFPA. Peru. https://www.youtube.com/watch?v=0pCqyVLoirY&t=4035s↩︎

  10. Considering an average yearly income difference of USD 599 between those who were able to postpone pregnancy and adolescent mothers.↩︎

  11. Sistema Integrado de Administración Financiera (2019)↩︎